Healthcare Reform

I spent about 20 adult years working in and around health care and healthcare policy as a bioethics teacher.  As a result, little in the current effort to reform something in healthcare and healthcare access (it’s not always clear which one is under discussion) has been a surprise to me.  Twenty years ago, discussions about rationing care, including expensive technology, were perfectly ordinary stuff including rationing that might lead to individual deaths.  We didn’t need Sara Palin to tell us about this possibility because we’d already had that happen with kidney dialysis and the infamous ‘God Committees’ in Seattle. 

But we also talked about things like how justice was served by ensuring that only one disease had treatment costs guaranteed (kidney failure)?  While people with other diseases were out of luck?  The story of how dialysis costs were covered under Medicare, even if the patients were not over the age of 65 was one of the basic stories my co-author and I covered in our 1986 book, Choosing Life or Death, a book for the general public about contemporary legal and ethical issues in healthcare.  (1986).  (A patient who would die without dialysis was wheeled onto the floor of the House of Representatives during the discussion of this healthcare bill.  That got results.)

Anyway, the health insurance debate if not giving me new information has surely been depressing as to effect.  It is indeed hard to think of the U.S. as an important, powerful country when it can’t get even policy as basic as healthcare competently structured.  More expensive, worse outcomes, and little evidence of effectiveness is the diagnosis, and the treatment is that everybody really needs to buy insurance.  Yikes.

Well, in the midst of all this, I had my own insurance experience that did surprise me.  I worked at UCLA and while I was there and since I retired (some 35 years total), I have had dental insurance from UC which the University pays for.  And it works okay even up here in Point Roberts where I routinely go to Canadian dentists.  The tooth numbers are different, the procedure codes are different, the currency is different, but eventually things get worked out, although I almost always have to have some additional interchange with them about whether they are going to pay.  I am helped by an earlier court case that required them to pay in a timely manner or add interest to the payment.  Delta Dental is the insurer.

Unfortunately, this spring, I had a tooth whose root cracked.  It had to be extracted and a permanent bridge installed to fill the space.  Expensive, but on the other hand, I have insurance.  Imagine my surprise when the insurance company refused to cover part of the procedure.  I thought it was the regular deal where they say no and i say yes and then they say okay or take half, or whatever.  The total cost of all this was to be around $3500, and I’d pay about half of it under the terms of the insurance.

But, no.  They refused part of the claim because I had ‘exceeded the maximum.’  Only at that point did I discover that for all those past years, UC has been paying about $500/year for me to have dental insurance whose maximum yearly payout is $1500.  (If I had stayed in California, the insurance would have no payout limit.)   This is remarkably like the Social Security Drug Insurance with the infamous ‘doughnut hole,’ except in this case, there is no doughnut, just a hole.  If you need help with a high-cost procedure, the insurance company says, ‘not our responsibility; our responsibility is the low cost stuff you could pay for yourself.’

The essential idea of insurance is that you pay to cover costs for something that has a low risk of happening but a high impact because of the likely high costs of the event.  $500 a year for a $1500 risk.  Just nuts.  Just right for another cog in the U.S. healthcare not-a-system.